3)

COMMUNITY PHARMACY

28
Evaluating Exam Preparatory Course

09
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(ID
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1
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LEGEND
t
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BTC: Behind-the-Counter
to

NAPRA: National Association of Pharmacy Regulatory Authorities

OTC: Over-the-Counter
Rx: Prescription
ed
ns
ce
Li

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 COMMUNITY PHARMACY: ROLE OF THE PHARMACIST

• Community pharmacists are the most accessible healthcare professional

• Primary role: safely and accurately supply medicines to patients with or, when
legally permitted, without a prescription

3)
28
• Additional roles:
• Inventory management: ensure an accurate supply of stock

09
• Patient care: counsel patients on use of prescription and non-prescription
drugs and provide services (e.g. medication reviews, minor ailments

:1
prescribing, injections)
• Interprofessional communication: serve as a drug expert for health

(ID
professionals within a patient’s circle of care
• Health promotion: participate in health promotion programs
y
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COMMUNITY PHARMACY: OVERVIEW

t
Da
to
ed
ns

Product Dispensing
Storage
acquisition Process
ce
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 3)
28
PRODUCT ACQUISITION

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PRODUCT ACQUISITION
t
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• Pharmacies acquire medications through wholesalers

to

• Wholesalers partner with manufacturers and customers to distribute

pharmaceutical drugs and consumer products to pharmacies
ed

• Example of wholesalers in Canada: McKesson Canada, Kohl & Frisch

ns

• Benefits: stable, rapid and secure product delivery

• Barriers: backorders, recalls, counterfeit drugs, cost
ce

• Pharmacies can acquire medicines from wholesalers independently or through

Li

buying groups
• Buying groups: one group made up of multiple independently-owned
pharmacies
• Buying groups improve negotiating abilities

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 MEDICATION SUPPLY CHAIN IN CANADA

Drug manufacturer submits research on a new drug product to Health Canada

3)
Drug receives approval upon review of safety, efficacy and quality of the new drug product

28
Federal, provincial and/or territorial agencies managing drug prices will conduct a review to

09
decide if the new medication will be included into the public drug plans and under what terms

:1
Once procured, the pharmaceutical company can use distributers and the Canadian
Pharmaceutical Distribution Network to distribute their medications in bulk to pharmacies

(ID
Healthcare professionals prescribe, deliver and/or administer medications to patients
y
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NAPRA
t
Da

• NAPRA: National Association of Pharmacy Regulatory Authorities

to

• Main purpose:
• Serve its members (pharmacy regulatory authorities across Canada)
ed

• Provides the public with information and guidance on pharmacy regulation in Canada

• Works on behalf of members to:

ns

• Create national model standards and guidelines for members to adopt or adapt, harmonizing
pharmacy practices and facilitating professional mobility
ce

• Represent Canadian pharmacy regulatory authorities in discussions with federal, domestic, and
international agencies and health organization
Li

• Administer programs like the National Drug Schedules and Pharmacists’ Gateway Canada
• Provide a platform for addressing common issues in Canadian pharmacy practice

• Members:
• Regulate pharmacy practice in their regions with a focus on protecting and serving the public
interest
• Offered a platform from NAPRA to address common issues in pharmacy practice nationally

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 NATIONAL DRUG SCHEDULES (NDS)

• A national model that aligns the provincial/territorial drug schedules allowing for consistent
conditions of sales for drugs across Canada

• Guides the level of professional intervention necessary for the safe and effective use of drugs

3)
• Conditions for sale outlined by three schedules or four categories:

28
1. Schedule I - RX

09
2. Schedule II - BTC
3. Schedule III - OTC

:1
4. Unscheduled - can be sold from any retail outlet

(ID
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STORAGE
ce
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10

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 STORAGE: NATIONAL DRUG SCHEDULES (NDS)

Schedule I Schedule II Schedule III Unscheduled

• Require • Prescription • Prescription • Prescription

prescription NOT NOT NOT

3)
for sale required for required for required for
• Not sale sale sale

28
available for • NOT • Available for • Available for
self-retrieval available for self-retrieval self-retrieval
self-retrieval where without

09
• Requires
pharmacist and requires pharmacist pharmacist
intervention pharmacist is present supervision

:1
• Prescription intervention • OTC (Over- • Sold in any
products • BTC (Behind- The- retail outlet

(ID
the-Counter) Counter)
products products

HIGH RESTRICTED ACCESS y LOW

nr
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SCHEDULE I
Da
to
ed

SCHEDULE
ns

II
ce
Li

SCHEDULE III: Located within

10 m (30 ft) of dispensary

12

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 STORAGE: CONTROLLED PRODUCTS
Controlled Products

Narcotic Controlled Drugs Benzodiazepines and

3)
Targeted Substances
DRUGS PREPARATIONS

28
• Products with • Products
only 1 narcotic containing only 1
(“straight” narcotic

09
narcotics) (excluding the 5 PART I PART II PART III
• Narcotics used listed as part of
parentally “drugs”) + 2 or DRUGS: • Listed in the Schedule to
DRUGS: DRUGS:
• Products with more non- • Listed under Part I of the Benzodiazepines and
• Listed under Part II of • Listed under Part III of

:1
> 1 narcotic narcotic Schedule to Part G of Other Targeted
Schedule to Part G of Schedule to Part G of
• Narcotics with ingredients at a FDA Substances Regulations
FDA FDA
< 2 other non- recognized • Products contain only • E.g. Alprazolam,
• Most barbiturates e.g. • Anabolic steroids and
narcotic therapeutic dose 1 or more than 1 lorazepam
phenobarbital derivatives (e.g.

(ID
ingredients • Verbal controlled drug testosterone)
• Products prescription • Amphetamines, PREPARATIONS:
containing narcotics methylphenidate, etc. • 1 controlled drug + 1 or PREPARATIONS:
heroin, EXEMPTED CODEINE
more non-controlled • 1 controlled drug + 1 or
hydrocodone, PREPARATIONS PREPARATIONS: ingredients more non-controlled
methadone, • Up to 8 mg/solid PO

y
• 1 controlled drug + 1 • Tecnal ingredients
oxycodone, or dosage of codeine OR or more non- • NOT available in
20 mg/30 mL liquid + 2
pentazocine controlled ingredients
nr
Canada
or more active non- • NOT available in
narcotic ingredients Canada Copyright © 2024 PharmAchieve Corporation Ltd. Private and Confidential.
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1. What is the difference between each product?

2. What is the drug schedule of each?
3. Where should each product be stored in the pharmacy (incl. public access and visibility)?

14

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 APPLICATION IN PRACTICE
Written/faxed? Verbal? Refills? Transfers?

Narcotic Drugs
Narcotic Preparations
Only for written/faxed if #refills AND
Controlled Substances Part I

3)
interval between refills indicated
If #refills AND interval between refills
Controlled Substances Part II, III indicated

28
Targeted Substances Once only
Valid if < 1 year since

09
prescription issue date

:1
(ID
y
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STORAGE: REFRIGERATED DRUG PRODUCTS

t
Da

Cold Chain: a temperature-controlled supply chain designed to transport and store

products such as pharmaceuticals, vaccines, and blood products within a specific
to

temperature range to ensure their efficacy and safety

ed

Guidelines for Storage

• Separation: Keep drugs separate from non-drug items (e.g. food)
ns

o o
• Temperature: Store drugs between 2 C and 8 C, using an alarmed thermometer
for monitoring
ce

o o
• Frozen vaccines: Maintain a temperature range between -50 C and -15 C
• Cold chain integrity: Ensure vaccines are kept in optimal conditions from the
Li

time of manufacture until administration to maintain their effectiveness

Cold Chain Breaks

• Definition: A break in the cold chain occurs when vaccines are stored outside
their recommended temperature range
• Action: If a break occurs, immediately separate the affected supply and contact
your local public health unit or the manufacturer for guidance
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 STORAGE: ANTIBIOTICS

Refrigerate Room Temperature Either

Azithromycin Yes Yes Yes
Amoxicillin Yes Yes Yes*

3)
Amoxi-Clav Yes

28
Cephalexin Yes
Cloxacillin Yes

09
Clarithromycin Yes
Clindamycin Yes

:1
(ID
*Refrigeration preferred
y
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STORAGE: MISC REFRIGERATED DRUG PRODUCTS

t
Da

Drug Name Storage Requirements Stability Outside of Conditions

to

Fludrocortisone (Florinef®) Refrigerate at 2°C - 8°C until N/A

expiry
ed

Do not freeze
Latanoprost Ophthalmic Refrigerate at 2°C - 8°C until 6 weeks if opened and stored
Drops expiry at temperatures up to 25 °C
ns

Do not freeze
Vyzulta® Drops Refrigerate at 2°C - 8°C until During shipment, stable up to
ce

expiry 40°C for up to 14 days

Do not freeze Once opened, store at 2-25 °C
Li

for 8 weeks

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 WHAT IS THE DIFFERENCE BETWEEN EXPIRY AND BEYOND-
USE DATES?
• Expiry date: date after which the drug product is not stable or
does not meet therapeutic requirements The BUD cannot be later
than the expiry of any
• Beyond-Use Date (BUD): the final date a compounded component of the mixture

3)
medication can be safely used, determined by several factors
General rules for non-sterile compounded drugs as per

28
•
NAPRA (in the absence of stability information):

09
BUD is not later than the time remaining until the
Non-aqueous formulations earliest expiry date of any active ingredient or 6

:1
months, whichever is earlier
Water-containing oral BUD is not later than 14 days with storage at

(ID
formulations controlled cold temperatures
Water-containing topical/dermal,
mucosal liquid and semi-solid BUD is not later than 30 days
formulations y
nr
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DISPENSING PROCESS
ce
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 DISPENSING PROCESS

1. Receiving Prescription

2. Transcribing

3)
28
3. Packaging

09
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4. Administration

(ID
5. Monitoring

y
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RECEIVING PRESCRIPTION MEDICAL CENTRE

t

ADDRESS
Da

PHONE NUMBER

• Prescriptions written by healthcare practitioner (e.g. Eva Liu

34 Woodstock Drive
Today’s Date

physician, veterinarian, dentist) or new class of

to

London ON
practitioners (e.g., nurse practitioner, midwife, DOB: March 12 1975
Tel# 225-239-2019
podiatrist) or pharmacist with prescribing authority
ed

(in provinces where this exists)

• Hand-written or printed, faxed, e-prescribed Oxycodone 20 mg IR tabs
ns

• Must contain: T1T PO Q6H PRN

• An image of a signature for verification of Mitte: 100 tabs
authenticity
ce

Pharmacist instructions: Dispense 30 tabs every 5 days

• Date Repeats: 1
• May be partially pre-printed – What does that mean?
Li

• Identify fake prescriptions

• Can a physician’s secretary verbally relay prescription
information to the pharmacist? Yes, must include
secretary name and doctor’s license
Dr. Marie Allan, ND #3346
Can this prescription be filled as written?

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 RECEIVING PRESCRIPTION
MEDICAL CENTRE
ADDRESS
PHONE NUMBER

Eva Liu Today’s Date

34 Woodstock Drive
London ON
DOB: March 12 1975 Refills are not
Tel# 225-239-2019
permitted on

3)
narcotic
prescriptions.

28
Oxycodone 20 mg IR tabs
Eva’s health card number is missing. T1T PO Q6H PRN
A government-issued ID number must Mitte: 100 tabs

09
be on every narcotic prescription. Pharmacist instructions: Dispense 30 tabs every 5 days
Repeats: 1

:1
Naturopathic Doctors (NDs), are not

(ID
authorized to prescribe narcotics.
Medical Doctors (MDs), Nurse
Practitioners (NPs), midwives, dentists, Dr. Marie Allan, ND #3346

and podiatrists are authorized to

prescribe narcotics. y
nr
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TRANSCRIBING MEDICAL CENTRE

t

ADDRESS
Da

PHONE NUMBER

Eva Liu Today’s Date

34 Woodstock Drive
to

London ON
DOB: March 12 1975
Tel# 225-239-2019
ed

Oxycodone 20 mg IR tabs
ns

T1T PO Q6H PRN

Mitte: 100 tabs
ce

Pharmacist instructions: Dispense 30 tabs every 5 days

Repeats: 1
Li

Dr. Marie Allan, ND #3346

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 TRANSCRIBING: INTERCHANGEABILITY
Same quantity of active ingredients
Comparable pharmacokinetics
Same route of administration
Same dosing schedule

3)
Price does NOT exceed that of “brand”

28
What does a “generic product” mean?

09
• Same chemical ingredient, same mechanism of action in the body
• When should the brand name be used?

:1
• If the patient requests brand or insufficient stock of generic or if “do not substitute”
is indicated on prescription

(ID
• If a new prescription is faxed over to the pharmacy for a new patient, would you fill
brand or generic (assume patient is not answering the phone and is expecting the
medication to be ready in 15 minutes)?
• Generic!
y
nr
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TRANSCRIBING: CHECKING PRESCRIPTION HARDCOPY

t
Da

This is a sample hard copy of a prescription

in a community pharmacy in Ontario – the
to

computer software is Kroll Computer

Systems.
ed
ns

Patient’s phone number

Gender
ce
Li

Physician’s license number

Office phone number

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 TRANSCRIBING: PRESCRIPTION LABEL

3)
28
09
:1
(ID
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TRANSCRIBING: COMMON ERRORS

t
Da
to

Verbal Prescription Written Prescription

ed
ns

• Prescriber’s tone / accent / speed • Illegible handwriting

• Environment (e.g. busy, noisy) • Abbreviations (e.g. OD and od)
ce

• Number clarity (15 vs 50) • Look-alike medications (e.g. Toradol and

• Sound-alike medications (e.g. Celebrex and Tramadol)
Li

Celexa) • Incorrect patient

• Similar/same patient name • Poor fax copy/transmission
• Closed-ended questions

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 What is an “independent double
PACKAGING: FILLING AND CHECKS check?” Involves verification by two
authorized individuals in absence of
the first authorized individual

Filling Technical checks Clinical checks

• Drug: Ensure the drug • Can be performed by • Only performed by RPh

3)
on the label matches RPhT or RPh • Check for: Therapeutic
the physical product • Check for: Correct appropriateness and

28
• Count: Ensure the count patient name, drug counselling
on the label matches name/dose/form/route, • Can pharmacy
prescriber, quantity,

09
the count of the students/interns
product number of refills perform clinical checks
• Can any pharmacy staff independently?

:1
• Label: Ensure the
prescription label is member prepare blister Yes!
correct packs?

(ID
Yes, but the final check
must be completed by
RPhT or RPh

y
nr
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PHARMACY STAFF ROLES

t
Da

PHARMACIST (RPh)
• Can perform all pharmacy tasks
to

• Primary role: clinical tasks

REGISTERED REGISTERED
PHARMACY
ed

PHARMACY PHARMACY
ASSISTANT
TECHNICIAN (RPhT) STUDENT/INTERN
ns

Receive new and repeat verbal Not controlled

prescriptions from other HCPs substances
ce

Perform independent technical

prescription checks
Li

Not
Accepting/sending transfer benzodiazepines
and targeted
prescriptions from other pharmacies substances
Perform test on tissue below dermis
Administer vaccine Only publicly
funded
Prescribe (Minor Ailment, Smoking
Cessation, Renewing or Adapting
Existing Rx)
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 ADMINISTRATION

• Indication: Discuss the medication's purpose and expected outcomes

• Use:
• Provide clear instructions on how to take the medication
• Demonstrate the correct administration technique (e.g., inhaler, injection)

3)
• Educate patient on the importance of adherence to the medication regimen

28
• Side effects: Review the potential side effects and how to manage them

09
• Monitor: Advise patient of your plan for follow-up

:1
• Support:
• Offer additional support such as medication synchronization and reminder services

(ID
• Ensure accessibility of pharmacy services, including home delivery if needed
• Provide language support or translation services as required

y
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MONITORING
t
Da

• Schedule follow-up appointments (often by phone) to monitor the patient’s

to

progress
• Adjusting the medication as needed based on patient response
ed

• Report any adverse reactions or issues to the prescribing physician

• Especially important for minor ailments
ns
ce
Li

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 MONITORING: RECALL
• Recall: the decision by a pharmaceutical company to remove products from consumer access
• Three types of recall:

Class I

3)
• Use of product will cause serious health consequences or death

28
09
Class II

:1
• Use of product may cause acute health effects

(ID
Class III

• Use of product is unlikely to cause harm

y
nr
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n
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CASE 1
t
Da

A mother arrives at your pharmacy with a prescription for her child, LM, who weighs 18 kg. The
prescription is for amoxicillin/clavulanate (liquid suspension) with a dose of 75 mg/kg/day of
to

amoxicillin, divided TID for 10 days.

ed

The brand of amoxicillin/clavulanate you have available in your pharmacy is Clavulin-400® (containing
400 mg amoxicillin and 57 mg clavulanate per 5 mL) which is available in a bottle size of 70 mL.
ns

What volume of Clavulin® does LM have to take TID?

ce

a) 5 mL
Li

b) 5.6 mL
c) 12.32 mL
d) 16 mL
e) 16.88 mL

How many reconstituted bottles do we have to give LM?

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 CASE 2

WQ is a 25-year-old male who states that he has only one Epipen® (epinephrine)
at home that expires next month. He heard that Epipens® are currently on back-
order.

What do you tell WQ?

3)
a) "Since your Epipen® expires next month and there is a back-order, you

28
should try to get a prescription for an alternative brand or generic version of
epinephrine auto-injector.“

09
b) "You should use your expired Epipen® if needed, as epinephrine can still be
effective past its expiration date.”
c) "Contact your pharmacy regularly to check on the availability of Epipens®

:1
and ask if they have any recommendations for obtaining one sooner.”
d) "Check with local hospitals or urgent care centres, as they may have Epipens®

(ID
available or know where you can get one.”
e) "It's important to avoid allergens strictly until you can obtain a new Epipen®,
to reduce the risk of an allergic reaction."

y
nr
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CASE 3
t
Da

An RPhT answers the phone at your out-patient clinic. A physician is calling in prescriptions for
venlafaxine and clonazepam.
to

Can the RPhT accept both prescriptions?

ed

a) Yes, the RPhT can accept both prescriptions over the phone without any restrictions
b) No, the RPhT cannot accept either prescription over the phone
ns

c) The RPhT can accept the prescription for venlafaxine, but not the one for clonazepam
d) The RPhT can accept the prescription for clonazepam, but not the one for venlafaxine
ce

e) The RPhT can accept both the prescriptions over the phone, but the pharmacist should be listening
in to ensure accuracy
Li

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 CASE 4

A patient comes into your outpatient clinic asking for help to take a blood pressure reading.

Can an RPhT perform this task?

a) Yes, an RPhT can perform a blood pressure reading without any restrictions

3)
b) No, an RPhT cannot perform any patient care tasks, including blood pressure reading
c) Yes, an RPhT can perform a blood pressure reading if they have been trained and it is within the

28
clinic’s policy
d) No, only a registered nurse (RN) or physician can perform a blood pressure reading
e) Yes, an RPhT can perform a blood pressure reading, but only under direct supervision of a pharmacist

09
:1
(ID
y
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n
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CASE 5
t
Da

You are a pharmacy manager at a community pharmacy that is part of a Family Health Team (FHT). It has
been brought to your attention that some of the oral hydrocodone medications are expired.
to

What is the best course of action?

ed

a) Continue to dispense the expired hydrocodone until a new supply arrives

ns

b) Immediately remove the expired hydrocodone from the shelves and properly dispose of it according to
regulatory guidelines
c) Mix the expired hydrocodone with other medications to reduce its potency before disposal
ce

d) Donate the expired hydrocodone to a local health clinic for their use
e) Store the expired hydrocodone in a separate area and notify the drug manufacturer for further
Li

instructions

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 CASE 6

You are a pharmacy manager at a community pharmacy that is part of a Family Health Team (FHT).
How often should physical counts and reconciliation of all narcotics, controlled drugs and targeted
substances be conducted?

a) Once a year during the annual inventory audit

3)
b) Every six months to ensure compliance
c) Monthly to maintain accurate records

28
d) Weekly to ensure tight control and monitoring
e) Daily to prevent any discrepancies

09
:1
(ID
y
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n
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CASE 7
t
Da

You are a pharmacy manager at a community pharmacy that is part of a Family Health Team (FHT).
to

It has been brought to your attention that there was a theft of all oxycodone products last night.

What is the best course of action at this time?

ed

a) Order a new supply of oxycodone products immediately

ns

b) Notify the police, the regulatory authority, and complete an internal investigation and inventory
reconciliation
ce

c) Wait to see if the stolen products are recovered before taking any action
d) Notify the patients with oxycodone prescriptions about the theft and ask them to come back
later
Li

e) Report the theft to your supervisor and continue normal operations

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 REFERENCES
1. OCP website. [Link]
asked-questions/
2. NAPRA Drug Schedules. [Link]
3. Protecting the Cold Chain. [Link]
content/uploads/documents/Protecting_the_Cold_Chain_Part_I.pdf

3)
4. CHAPTER 1 - PHARMACY IN CANADA. [Link]

28
5. Medication Supply Chain. [Link]
supply-chain/

09
6. PBA Health. Pharmacy Buying Groups: What to Know Before You Join. March 2022.
[Link]

:1
group/#:~:text=But%20you%27re%20a%20pharmacist,you%20the%20best%20deal%20possible

(ID
y
nr
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CHANGE LOG
t
Da

October 2023
• Content reviewed; no changes made
to

March 2024
• Formatting changes made throughout
ed

• Added Slide 6
• Slide 15: Updated information on storage
ns

• Slide 18: Updated the case

June 2024
ce

• Significant changes throughout

Li

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